Practical Utility of Widefield OCT Angiography to Detect Retinal Neovascularization in Eyes with Proliferative Diabetic Retinopathy

To assess the real-world clinical utility of wide-field OCT angiography (WF-OCTA) for detecting retinal neovascularization (RNV) in eyes with proliferative diabetic retinopathy (PDR). A retrospective cross-sectional study. Consecutive eyes clinically suspected of PDR by physicians at a tertiary eye center between March 2021 and November 2022. All eyes underwent ultra-widefield fluorescein angiography (UWF-FA) (California, Optos) and WF-OCTA (S1, Canon) with a 23×20 mm scan area. Two independent graders detected individual RNV lesions using UWF-FA and used them as the ground truth. WF-OCTA images were first evaluated to determine whether the images successfully illustrated retinal vasculature, regardless of the image quality index or the presence of vitreous hemorrhage. The graders then identified the RNV lesions with WF-OCTA. We detected RNV by utilizing both the whole retinal slab, including flow signals in the retina, and the custom vitreoretinal interface slab, defined as flow signals from 20 microns below the internal limiting membrane (ILM) to 2000 microns above the ILM. We evaluated the applicability to real-world clinical practice by not correcting segmentation errors. The success rate of imaging and the detection rate of RNV using WF-OCTA. Initially, 69 consecutive patients who underwent UWF-FA were identified. Of these, 114 eyes from 57 (83%) patients underwent both UWF-FA and WF-OCTA. Of the 114 eyes, 108 (95%) produced gradable WF-OCTA images. Using UWF-FA, the graders identified 175 RNV lesions in 40 eyes. WF-OCTA achieved a sensitivity of 95% and specificity of 88% for detecting eyes with RNV. At the level of individual RNV lesions, graders detected 156 RNV lesions with WF-OCTA, with 118 of these confirmed by UWF-FA (true positive). Among the 57 false negative lesions, the primary causes were being out of the scan range (26 lesions) and segmentation errors (21 lesions). WF-OCTA imaging had a high success rate, achieving a sensitivity of 95% and a specificity of 88% for detecting eyes with RNV in a real-world clinical setting. Despite a 67% detection rate for individual RNV lesions, WF-OCTA may serve as a valuable non-invasive method for RNV detection in eyes with DR.